The News Story: Labour Politicians Call on Mrs. May For More Spending on Mental Health

The New Research: Preventing Suicide—Family Connections as Safety Net

The News Story: Labour Politicians Call on Mrs. May For More Spending on Mental Health

October 10 was World Mental Health Day, and 160 Labour MPs took the opportunity to write a letter to British Prime Minister Theresa May, asking that she “make a vital change that will advance the cause of mental health.”

At issue is a sensed disparity between the Government’s expressed concern over mental health issues, and what Labour MPs see as a lack of appropriate action on these items. Because most mental health funding is not “ring fenced” (set aside so as to restrict its use), the Daily Mirror reports, “the concern is that cash-strapped NHS trusts use any extra funding to plug gaps elsewhere.” The story continues, “More than 6,000 mental health nurses and doctors have been cut from the NHS in England since 2010. . . . For the fourth year in a row, the government has failed to deliver on its promise to increase the money reaching frontline services.”

And although such concerns are certainly valid in an age in which mental health issues (particularly in developed nations) continue to rise, research demonstrates that the problem runs far deeper. Until policymakers spend more time and resources encouraging families to stay together, many of the funds directed at mental health services will be but a Band-Aid response.

With suicide rates in the United States surging to their highest level in decades, public-health officials are looking with a keen sense of urgency for strategies to prevent such deaths. Unfortunately, in a world where low marriage and fertility rates and high divorce rates are leaving unprecedented numbers of people without the support of spouse or family, their search may prove unavailing. Indeed, according to a study recently completed by researchers at Rice University, a person’s vulnerability to suicide depends first on whether that person lives with spouse or family and then on whether that person lives in a community filled with family households.

The Rice team began their new study cognizant of the scope of the problem in view. “In the U.S. alone,” they write, “suicide accounts for nearly 40,000 deaths annually.” In framing their inquiry into this distressingly large tragedy, the researchers draw on the thinking of Emile Durkheim, the sociological pioneer who believed that “suicide was an inherently social act, one that is heavily influenced by broader social factors and thus could not be understood solely at the individual level.” Consequently, though the Rice scholars do look at individual characteristics in their investigation of suicide risk, they also examine the broader social context, especially as that context is defined by socioeconomic disadvantage and family living arrangements.

To gauge the impact of individual characteristics and social context on suicide risk, the authors of the new study examine data collected by the National Health Interview Survey from almost one million adults between 1986 and 1993, linking those data with 1990 and 2000 Census data, correlated with mortality numbers through 2006. The focus on adults, the researchers explain, reflects confidentiality concerns relevant for suicides under age 18.

Through statistical analysis, the researchers establish that both individual characteristics and social context affect suicide risk. Of course, individual characteristics actually point toward social context when those characteristics reflect marital status and family-living arrangement. And these marital and family-living characteristics matter for suicide risk: the Rice scholars conclude that divorced and separated individuals face a significantly higher suicide risk than do married peers (p < 0.01). They also conclude that individuals face a significantly lower suicide risk if they live in a family comprising four or more members rather than in a smaller household (p < 0.01).

Furthermore, when the researchers shift their focus from individual characteristics to community characteristics, Durkheim’s theoretical emphasis on social context looks fully justified. In these community-level analyses, the researchers compare Metropolitan Statistical Areas (MSAs) with relatively high numbers of family households with MSAs with relatively low numbers of such households. For these comparisons, the researchers define family households as those involving “married-couple families and other family types (male or female householder with no spouse but with children or other relatives).” Non-family households in these analyses were those involving individuals “living alone or with other nonrelatives.” These comparative analyses clearly establish that, “compared to MSAs with the highest proportion of residents living in family settings, persons in MSAs with the fewest family living residents have odds of suicide 2.4 times higher over the follow-up period.”

Even when the researchers repeat their community-level analyses using statistical models that adjust for the individual-level characteristics, they find that “regardless of their own marital status and family size, persons living in the lowest family-living type MSAs have odds of suicide that are twice as high as persons living in the highest family-living MSAs” (Odds Ratio of 2.03; p < 0.01). What is more, in their most sophisticated statistical models the researchers find that “family living related powerfully to both men’s and women’s risk and both younger and older respondents’ [risk].” In contrast, socioeconomic disadvantage in an MSA was “significantly associated with an increased suicide risk only for men,” and not for women. In other words, regardless of their own personal household circumstances, living in a community largely composed of family households protects both men and women, both young and old, from the temptation to suicide.

After reflecting on the policy implications of their findings, the Rice scholars hope their research can “contribute to reducing the risk of suicide by encouraging more investment in both individual and area level resources aimed at fostering social integration and connectedness and eliminating socioeconomic disadvantages.” “Reducing suicide mortality,” they assert, “can lengthen overall life expectancies and result in stronger, richer, more tightly knit communities.”

Unfortunately, until wedding chapels start filling and divorce courts empty out, until more women are headed for maternity wards and fewer for abortion clinics, phrases such as “social integration and connectedness” will remain empty abstractions, and hopes for “more tightly knit communities” will prove vain. Only a genuine renewal of marriage and family life seems likely to end the alarming epidemic of suicide.